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Form Department ot the Treasury - Intema! Revenue Senrice ~
iRev. Seplember 1978) Certific~t~ -of Release of Federai Tax Lien
District Serial Number 562310 For Optlona? Use Dy Reco~aing Office
~~~~u~ BK 3 74 PG 14 71 ~1,~~
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1 certify ihat as to the following-named taxpayer, the requirements of section 6325(a) F,i . S ,
of the Internal Revenue Code have been satisfieci for the taxes listed below and c~ ~~f ^c::f:
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ior ait statutory additions. Therefors, the lien provided by Code section 6321 for i~ j.,:;; " !
these ta~ces and additions has been released. The proper officer i[~ ihe office ~e ; F K`~~:;` `
where the notice of internal revenue tax lien was fited on April 13 , j
19 82 , is authorized to note the books to show the release of this lien for
these taxes and additions.
vame of Taxpayer ~~~+7~~a7~ ;
Sobeort Dille~r I
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P~o~t $t. I4Ci~s F~,d• 33~'SZ
UnpaEd Balance
Kind ot Tax _ Tax Period Eacied Dats of A~essment ldentifyin9 Numbar of Assessment
(a) (b) (W (dl (e)
, 1t~0 1~-31-?6 QS-i6-7e1 3t0'~-?A"~ 66b.85
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This certificate was prepared and signed at Jacksonville, Florida , on this,
ihe lst dayof August ,19 83
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; Siynature Title
BOOK
~ . endler Chief , Advisory Unit ~
(Npt~: Csrtilic~te ol oHicsr authorized by law fo take ~cknowl~dpmMts /s ~ot ~ss~ntl~1 fp tAS v~li0ity oi Notic~ of
F.os..i r.x ~;ao G.C.M. 281t~, i~sa~, c.B. ~25.~ cs ccc 8-1_83
Part 3- To be used for recording purposes Form 6~3 (Rev. 9-78)
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